Mentor Application Form

Personal Information

First Name *

Last Name *

Email *

Phone Number *

City *

State *

Employment

What is the name of your employer? *

Job Title *

Career Field *

Years of experience in field *

Education

What is your highest level of completed education? *

List the name of your graduating degree field(s) *

What institution did you attend? *

What were your campus involvements?

Mentorship

Have you ever participated in a formal mentorship program? *

If yes, please explain

Outside of your current employment and education, what other areas of expertise could you offer a mentee? *

What are your civic activities (i.e., Junior League, Rotary, elected official, nonprofit boards, professional memberships, volunteering)? *

What type of qualities do you prefer in a mentee so that we can match you with the appropriate student? (i.e.: personality, academic, background, career goals, etc) *

Are you prepared to provide mentorship in career guidance and exploration, life skills, and networking? *

Can you provide job shadowing opportunities for your mentee?

Is there any other information you would like for us to consider when pairing you with a mentee?

Submission of an application does not guarantee admittance into the program.

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